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Friday, February 01, 2008

Cancer's Calling Card

Foreword: I'm not a medical person, or any kind of expert. This post shouldn't be taken as God's word carved in stone by Moses. In other words, don't consider it to be any kind of authority or use it to treat, diagnose, or select medications. Do your own research and talk to your doctor, an actual expert, who, you know, went to medical school and stuff. This post is merely my best understanding of cancer and cancer treatment and prevention, as related to our situation, based on what I've learned from reading and talking to doctors.

Author's Note: If you aren't interested in the cancer discussion and the things I learned, and only want to know the outcome of our appointment with the oncologist yesterday, skip to the end. I've divvied this up by sections, so go to the last section.

What would you do if one day a postcard arrived in the mail to warn you that sometime in the next three years you would be diagnosed with cancer?

Would you believe it? Change anything? Find it inevitable? Fight against it?

Do you think you could get a doctor to believe you?

This isn't the plot for a new horror film, it's our life.

Last year I got a calling card, and this year our dog did. I believed it. I began changing my life. It hasn't been radical, but it has been slow, sure and steady. It's involved a lot of things---consider everything you use on your body, in your life, and everything you eat as well as how you live---and has included an amazing journey of discovery of theories about how to live a cancer-free life.

Not too long ago I learned about COX-1 and COX-2.

What are cyclo-oxygenase enzymes and what do they have to do with cancer?

...cyclo-oxygenase (COX), which catalyses the conversion of arachidonic acid to prostaglandins (PGs). PGs are important mediators of signal transduction pathways, and are involved in cellular adhesion, growth and differentiation.

Did that clear it up for you?

Okay I'll let my dog's oncologist explain it:

Cells are supposed to die. When cells become cancerous, they don't die off; they grow, spread and proliferate. That's bad. It takes over healthy cells. You get sick.

In short, cyclo-oxygenase (an enzyme---see, note the ending of the word: ase. That tells you it's an enzyme) is involved in this process. The body releases cyclo-oxygenase (which we'll call COX from now on) when it is inflamed, and also precancerous tissue emits COX. There are two versions of COX: 1 and 2.

For over a decade, inhibition of the COX-2 enzyme has been linked to preventing and treating cancer. That's why for quite a while doctors and researchers have been looking at the benefit of non-steroidal anti-inflammatories (NSAIDs, such as aspirin and ibuprofen) for cancer patients. The problem with these is that they block both COX-2 (which is more directly linked to cancer, from my understanding) and COX-1.

The problem with blocking COX-1 is that it can cause problematic side-effects, such as gastrointestinally (stomach bleeding, for example). Some doctors began to believe the risk of long-term NSAID use outweighed the potential benefits.

Enter the next class of drugs that only inhibit COX-2. You have probably heard of these drugs, for example Pfizer's Celebrex. These were designed to treat arthritis, but because a decade of research has indicated that COX-2 inhibitor drugs may prevent and moreover, treat, cancer, many places have been studying (through clinical trials) the potential of these drugs. The results are...hopeful.

Note: This is an oversimplified and incomplete discussion of this. I suggest reading some journal articles that describe it in more detail if you are interested.

How do the COX-2 inhibitors treat and prevent cancer?

The process of converting procarcinogens (think something like 'good bacteria') into carcinogens (think something like 'bad bacteria' or 'plague') requires COX-2. COX-2 is also the enzyme that regulates the synthesis of prostaglandins from fatty acids. When this process doesn't happen correctly, it can promote the growth of tumors (tumorigenesis).

Note: Most doctors want people at their best lean healthy weight when dealing with cancer. Obesity might be a factor because of the role of fat cells and hormones and cancer and so forth.

In short, the theory is that if you stop COX-2 from creating carcinogens and tumors, you can stop cancer from happening.

Remember how my dog's oncologist said cells need to die and cancer inhibits this natural process (only using words like morphology)?

What if a drug, with minimal or no sides effects, without affecting healthy cells, could enter the body and cause cancer cells to die?

That's the possibility we are talking about here.

You can understand why there is what one might call excitement in the cancer community.

Here's how my oncologist looked: a tiny smile peeked out and he said, "We've had some positive results with that."

Me: I'd have danced and jig and clicked my heels up high in the air. Personally. But that's just me.

What's this got to do with the price of dog bones in Houston?

A little while back I added a drug called Xyflamend into my regimen. The intent was to manage pain and control inflammation (which is probably one and the same on the whole). Moreover, the hope was that I could stop daily need of pain medication, often NSAIDs.

Because I'm me I began researching this drug. As I did so, I noticed a fair number of articles popping up about COX-2 inhibition, cancer prevention and treatment, and specifically, a Columbia University clinical trial that had good success with managing prostate cancer using Xyflamend.

You can imgaine how excited I got.

This drug that was helping to manage my pain might help me avoid a future scare like last summer's?

Could this drug possibly help me avoid having to ever again take a tumor shrinking medication like cabergoline?

Count me in!

I'm all about no tumors in or near the brain or anywhere else, personally. But maybe that's just me.

So after our dog got his diagnosis, I began researching veterinary application of COX-2 inhibitors. Lo and behold.

The main research into COX-2 inhibitors seems focused on prostate and colorectal cancers. That's extremely relevant to my dog, who was diagnosed with adenocarcinoma, a colorectal cancer in the submucosa.

If you just heard mwah mwah mwah there don't worry. I just said, "My dog had a tumor in his rectum."

What did our dog's oncologist say when I walked into our appointment with three clinical studies from three major institutes, and a page full of questions about doing our best to treat this and save our dog?

He smiled. I think he left the room and laughed. I suppose the surgeon gave him a heads-up and he was surprised but not shocked.

It apparently surprises all medical professionals---animal and human---when a person takes the trouble to become educated about a disease and comes to an appointment armed with information and questions. It also surprises them when said people have ideas, theories, questions, and plans to play an active role in the health care. I find doctors for humans are Not Big Fans of this. I find doctors for animals are Happy and Pleased to meet Fellow Medical Nerds.

So what happened next?

Two doctors examined our dog: our surgeon and our oncologist. Neither found any evidence of a tumor left.

The oncologist initially presented two options that made me believe he thinks the reports were preliminary, a heads-up if you will, more than an actual diagnosis. In other words, I think he thinks there is cancer in our dog, at the microscopic level. That means pre-cancerous.

The cytology and histology found cancer because it's there, but we don't see it or find it in other diagnostic ways because it hasn't yet fully manifested itself.

Maybe.

Possibly.

This is, I think, one of those cases of more art than science.

The two options were: extremely serious and invasive surgery to do some more exploration and searching for possible cancer or regular and frequent check-ups. The idea in both of these options is to catch it early.

I was dissatisfied. Wait and see is not my method of operation. I'm a control freak proactive person who prefers to avoid dangerous and invasive things when possible.

So I counterproposed: what about body scan and considering a COX-2 inhibitor?

We all liked that plan. And so, that is the plan. Next week we'll take our dog back and they'll do a non-anesthesia, non-invasive body scan, examining the areas most likely to be cancerous based on what they found.

We'll consider our next move based on what we find.

A side note about COX-2 inhibitors and what the oncologist said...

COX-2 inhibitors are related to cardiac problems. This has created some controversy about using them, but hasn't halted the clinical trials.

The oncologist has a COX-2 inhibitor he's used with dogs. He says they don't carry the same risk with dogs as with humans, in part because of dosage.

However, the Zyflamend is supposed to be very low risk to humans and did not have cardiac problems associated with it. I felt that it was a possible choice for the dog, too. Our oncologist is not familiar with that drug, so I handed him the Columbia University research on it, and he's going to check into it.

Best case scenario: The scan reveals no additional cancer growths, we are in the pre-cancerous stage, we fall to our knees and thank God for the incredible heads-up, and begin doing our best to prevent this from going any further, which may mean using COX-2 inhibitors.

My husband and I left in shock. We fully expected a very serious and dire discussion that started at $5000 dollars. Instead, we left with a very mild next step and the oncologist's optimistic words ringing in our ears.

That's three optimistic doctors.

So how are we all doing now?

Last night, as we lay in bed, my husband and I talked about how neither of us had fully acknowledge what a ball of anxiety we had each been carrying, or how knotted up we were about this.

We were both knocked out exhausted. In fact, I sat on the couch with the kids after dinner, intending to read Patience's new book. Instead I turned on Sprout and unintentionally fell asleep. The kids covered me up and sat by me, watching TV.

When my husband got home, he schlepped the kids to bed and I dragged myself upstairs. We talked for a bit. We'd both been so anxious about the dog's health and the money. We'd been anxious about our ability to weather another crisis. It caused both of us to become more anxious about my health, too. We were so stressed.

Getting that ray of hope, believing that maybe we can skirt this on the best possible side, caused us to unravel inside a bit. Muscles we hadn't realized we'd clenched relaxed, and our bodies just wanted deep, deep sleep.

We woke up this morning, smiling, and decided to go to the Zoo.

Umm, what in the heck did Julie just say here and what am I supposed to say back?

On the whole, we are optimistic. It looks like we may have gotten to this cancer really, really early. If that's so, that broadens the possibility of treatment options and gives a better prognosis about potentially longer life.

We have hope.

More reading and things I used to research, learn and explain (a small sampling):

I totally understood this, from a combination of KayTar-related research and my A&P class. Everyone has precancerous cells in their body at just about any given time. If your body has the right internal climate and the proper defenses, they can killed off before they can multiply and take over. However, way too often that isn't the case.

I have definitely observed doctors (both in my wife's life and my parents') who do not appreciate educated patients. They are used to playing god and telling patients what they want and expect, and a patient who is educated suggests things they are not comfortable with or do not like to do annoys them.

Not in every case, but in most cases I've experienced, veternarians are pretty compassionate - they're animal lovers who got into that line of work to take care of animals. As such, they appreciate fellow animal lovers who want to take care of their pets and don't always opt to get rid of sick animals.

Glad you have some good news for your dog. I know I would not have been as good an owner to your dog as you have been.

Hi Julie,Doing your own research and being informed means facing the situation head on - that takes courage!How awesome that you and your family are standing on your own feet choosing knowledge and power as opposed to being passive and giving doctors all the 'power' (no wonder so many have god complexes!).Optimistic is a great way to be - especially when you consider that optimistic people live longer than pessimists. Hope the zoo was stacks of fun :-)Alison

Wow, the doctor was actually pleased that you were educated?! Doctors here have a tendency to HATE anyone who dares tell them they know what's going on. And he actually offered to look up a drug he didn't know because you'd been studying about it?! My GOD I'm glad to hear there are decent people in the medical profession!

How much of a harbinger is the dog's health of the possible effects of your environment on you, your husband, and your kids? Is that part of the giant ball of anxiety? While I am glad you can help your dog, I know you must be very worried about the people.

I'm so glad you're optimistic. And I'm glad your vet is open to your research. I've also found the doctors for humans are not so thrilled with this. Maybe I understand why they don't want us to google "coughing, death, cold" but real research should be welcomed. Your health *should* be a collaborative effort.

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